<p>Venous congestion is a major contributor to morbidity and mortality in several clinical settings. Relying on traditional methods for bedside evaluation of congestion often leads to inadequate decongestion and increased hospital readmissions. The Venous Excess Ultrasound Score (VExUS) was introduced by Beaubien-Souligny to improve assessment of systemic congestion by integrating inferior vena cava size and Doppler patterns from hepatic, portal, and intrarenal veins. This review aims to describe how to perform VExUS and summarize the current state of evidence based on original data studies either supporting its clinical use or recognizing limitations. Most of the knowledge regarding VExUS comes from studies assessing its prognostic role in predicting death, re-hospitalization, and acute kidney injury. VExUS proved to be a valuable prognostic tool in cardiologic settings such as patients admitted in intensive care unit after cardiac surgery and those hospitalized for heart failure; conversely its predictive performance is less consistent in more heterogeneous populations where patients are less prone to develop venous congestion. Importantly limited evidence supports VExUS utility in guiding management strategies. Further research is needed to establish whether the integration of a VExUS-guided decongestive diuretic therapy improves outcomes across different clinical settings. Moreover, concerns regarding its complexity, redundancy with single-site Doppler indices, and the absence of validation in broader populations have been raised.</p>